engMashhad University of Medical SciencesEvidence Based Care2008-24872008-370X2016-10-016371810.22038/ebcj.2016.76137613مقاله پژوهشی اصیل کمی و کیفیEvaluation of the Effects of Breast Cancer Screening Training Based on the Systematic Comprehensive Health Education and Promotion Model on the Attitudes and Breast Self-examination Skills of WomenKhadije Mirzaiik.mirzaii@gmail.com1Shadan Nessari Ashkezarinesarish921@mums.ac.ir2Talat Khadivzadeh3Mohammad Taghi Shakeri4Evidence Based Care Research Centre, Associated Professor of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranMS in Midwifery, Students Research Committee, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranEvidence Based Care Research Centre, Assistant Professor of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranProfessor of Biostatistics, Faculty of public health, Mashhad University of Medical Science, Mashhad, IranBackground: Improvement of attitudes toward breast cancer positively affects the screening behaviors of women. Imagery has been shown to have a positive impact on the screening behaviors of women. Aim: This study aimed to investigate the effects of breast cancer screening training based on the systematic comprehensive health education and promotion (SHEP) model on the attitudes and breast self-examination skills of women. Method: This quasi-experimental study was conducted at two urban healthcare centers of Mashhad, Iran in 2015. Participants were 120 women covered by these health centers, who received training on breast cancer screening based on the SHEP model. Intervention consisted of evaluation (literature review, topic selection), implementation (developing instruments, educator training, training of participants), and assessment (pretest-posttest). Data were collected using researcher-made questionnaires of attitude and breast self-examination (BSE) checklists. Data analysis was performed in SPSS version 20 using independent t-test and Mann-Whitney U test. Results: In the intervention and control groups, 55 (91.7%) and 56 (93.3%) participants were married, respectively. Results of Mann-Whitney U test before intervention showed no significant differences between the groups regarding the mean scores of attitude and breast self-examination skills (P>0.05). After a four-week follow-up, independent t-test revealed a significant difference between the groups in terms of the mean score of attitude (Phttp://ebcj.mums.ac.ir/article_7613_7c3924bbf47f78dce85d16606614b1da.pdfBreast self-examination (BSE)Breast Cancer ScreeningSystematic comprehensive health education and promotion modelattitudeengMashhad University of Medical SciencesEvidence Based Care2008-24872008-370X2016-10-0163193010.22038/ebcj.2016.76197619مقاله پژوهشی اصیل کمی و کیفیEvaluation of the Effects of Oronasal Versus Oral Disinfections with Chlorhexidine on Clinical Criteria of Ventilator-associated PneumoniaMahdi Alimialimim1@mums.ac.ir1Zahra Sadat Manzarimanzariz@mums.ac.ir2Seyed reza Mazlommazlomr@mums.ac.ir3Ahmad Bagheri Moghadam4Hossein Rouhani5MS in Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranAssistant Professor, PhD of Nursing, Department of Medical-Surgical Nursing, School of Nursing &amp; Midwifery, Mashhad University of Medical Sciences, Mashhad, IranEvidence Based Care Research Centre, Instructor of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranAssistant Professor, Department of Anaesthesiology and Critical Care, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IranAnesthesiologist, Shahid Kamyab Hospital, Mashhad University of Medicals Sciences, Mashhad, IranBackground: Ventilator-associated pneumonia (VAP) is the most prevalent and lethal form of nosocomial infections in the ICU and oral disinfection is a nursing measure to prevent this condition. Aim: this study aimed to evaluate the effect of oronasal versus oral disinfections with chlorhexidine on the clinical criteria for diagnosis of VAP. Method: This randomized clinical trial was conducted on 70 intubated ICU patients under mechanical ventilation at Shahid Kamyab Hospital of Mashhad, Iran in 2016. Samples were divided into two groups of intervention (mouthwash and disinfection of nostrils with 0.2% chlorhexidine every eight hours) and control (mouthwash). Clinical criteria for VAP, including pulmonary infiltration, rectal temperature, white blood cell (WBC) count and endotracheal discharge were recorded and compared between the two groups from days 1-6. Data analysis was performed in SPSS version 11.5 using Chi-square test. Results: In this study, mean age of intervention and control groups was 44.3±19.9 and 45.9±18.2 years, respectively. The results of Chi-square test indicated no significant difference between the groups regarding rectal temperature (P=0.22), WBC count (P=0.33), purulent endotracheal discharge (P= 0.47), pulmonary infiltration (P=0.21) and incidence of VAP (P=0.21). Implications for Practice: According to the results of this study, no statistically significant difference was observed between the two groups regarding clinical criteria and the incidence of VAP despite clinical differences. Therefore, it is recommended that further studies be conducted in this area.http://ebcj.mums.ac.ir/article_7619_f83dac3f22a3def22d4340b66db78b14.pdfVentilator-associated pneumoniamouthwashChlorhexidineMechanical ventilationengMashhad University of Medical SciencesEvidence Based Care2008-24872008-370X2016-10-0163313610.22038/ebcj.2016.76307630گزارش کوتاهIntroduction and Use of an Education-notification Application for Patients Undergoing Heart Valve ReplacementHaniyeh Jobranijobranih921@mums.ac.ir1Nahid Aghebatiaghebatin@mums.ac.ir2Shirzad Shahriyarish.shahryari@um.ac.ir3HamidReza Behnam Vashanibehnamhr@mums.ac.ir4Sadegh Sehatbakhshs.sehatbakhsh@um.ac.ir5Jamil Esfahanizadehesfahanizadehj@mums.ac.ir6MS in Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranEvidence Based Care Research Centre, Assistant Professor, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranInstructor, Department of Computer Science and Engineering department, Khorasan Institute of Higher Education, Mashhad, IranEvidence Based Care Research Centre, Instructor of Pediatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranInstructor, Department of Computer Science and Engineering department, Khorasan Institute of Higher Education, Mashhad, IranAssociate Professor, Heart surgery Department of Heart Surgery, School of Medical Sciences, Mashhad University of Medical Sciences, Mashhad, IranProper education and notification of patients undergoing heart valve replacement is of paramount importance. The past decade has witnessed a growing interest in the use of modern, advanced technologies in medicine and patient education. This study aimed to introduce an education-notification application for patients undergoing heart valve replacement. Research was carried out in two phases of software design and performance evaluation. The first phase consisted of two stages: development of educational materials and notifications befitting to the application and algorithm design. The second phase of the study involved the assessment of the viewpoints of 30 patients undergoing heart valve replacement using a researcher-made questionnaire. Validity and reliability of the questionnaire were confirmed using descriptive statistics and Mann-Whitney U test. According to the results, the designed education-notification software was described as “good” or “very good” by 81.3% (n=24) of the participants.http://ebcj.mums.ac.ir/article_7630_47ae202dde0a1aaddb861a81f265c501.pdfDesignAssessmentEducation-notification softwarePatients undergoing heart valve replacementengMashhad University of Medical SciencesEvidence Based Care2008-24872008-370X2016-10-0163374410.22038/ebcj.2016.76377637مقاله پژوهشی اصیل کمی و کیفیAssessing Readability of Patient Education Pamphlets in Training Hospitals in the City of MashhadMonir Ramezaniramezanimn@mums.ac.ir1Maryam Samimi Kalatsamimim3@mums.ac.ir2Fatemeh Heshmati-Nabaviheshmatinf@mums.ac.ir3Azadeh Sakisakia@mums.ac.ir4Evidence Based Care Research Centre, Assistant Professor of Pediatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranMS in Management Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranEvidence Based Care Research Centre, Assistant Professor of Management Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranEvidence Based Care Research Centre, Assistant Professor of Biostatistics, Mashhad University of Medical Sciences, Mashhad, IranBackground: Patient education is taken into account as one of the key components of comprehensive care as well as one of the significant nursing functions in order to increase community health. In this respect, education materials and written texts can improve patient information up to 50% and consequently meet patient satisfaction. Readability is considered as an integral concept in patient education and an appropriate measure to determine how contents are perceived by readers. Aim: The present study was to measuring the readability level of patient education pamphlets in training hospitals in the city of Mashhad. Method: This study was a descriptive research conducted in 2016. In order to measure the readability level, the Simple Measure of Gobbledygook (SMOG) Readability Test was used. The study sample included 543 patient education pamphlets used by 11 training hospitals in the city of Mashhad along with pamphlets developed by the Office of Vice-Chancellor for Treatment Affairs that were collected through the census method. The SPSS16 software was also employed for data analysis. In terms of descriptive analysis, mean and standard deviation were used. In addition, Cronbach’s alpha correlation test was employed for inferential analysis. Results: The average readability level of patient education pamphlets was estimated equivalent to 11th grade (11.35±1.05). Moreover, the minimum and the maximum readability levels of the pamphlets were 9th grade and 15th grade, respectively. Implications for Practice: The results revealed that patient education pamphlets available in training hospitals in the city of Mashhad were endowed with a high level of readability. Thus, the given pamphlets were appropriate to patients with a level of literacy equal to senior university students and they could not be perceived by the public. Considering the importance of readability index in health promotion and increased patient self-care, it was recommended to improve the readability level of patient education materials.http://ebcj.mums.ac.ir/article_7637_e64a0079e466bf234879492cb58056d4.pdfPatient EducationPamphletReadabilityReadability IndicesHealth LiteracyengMashhad University of Medical SciencesEvidence Based Care2008-24872008-370X2016-10-0163455410.22038/ebcj.2016.76547654مقاله پژوهشی اصیل کمی و کیفیComparing the Effect of Resistive Inspiratory Muscle Training and Incentive Spirometry on Respiratory Pattern of COPD patientsSeyed Hossien Ahmadi Hosseiniahmadihh@mums.ac.ir1Marjan Farzadm.farzad216@gmail.com2Abbas Heydariheydarya@mums.ac.ir3Pulmonologist, Department of Internal Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IranMS in Nursing, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranProfessor of Nursing, Evidence Based Care Research Center; Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranBackground: Resistive Inspiratory Muscle Training (RIMT) is a well-known technique for rehabilitation of patients with Chronic Obstructive Pulmonary Disease (COPD). Incentive spirometry is another technique with potential viability for this application, but there is limited evidence in support of its efficacy in the rehabilitation of COPD patients. Aim: The objective of this study was to compare the effect ofresistive inspiratory muscle training and incentive spirometry on respiratory pattern of COPD patients. Method: This study was a randomized clinical trial on 30 patients with moderate COPD who were referred, in 2011, to the pulmonary clinic of Emamreza Hospital of Mashhad (Iran). The patients were randomly divided into the RIMT and the IS treatment group. In both groups, exercise regimen consisted of two 15-minute sessions of exercise per day, in the morning and evening, four days a week for 4 weeks. Respiratory pattern (respiratory rate and depth) and dyspnea (at rest and during activity) were measured before and after exercise. Data was analyzed with the Mann-Whitney and ratio difference tests using SPSS v.11.5. Results: The average age was 50.8±10.7 in the IS group and 51±10.8 in the RIMT group. The statistical tests found no significant difference between the groups in terms of post-intervention exertional dyspnea, dyspnea at rest, tidal volume, and respiratory rate (P>0.05); but post-intervention maximal inspiratory pressure and maximal voluntary ventilation in the two groups were found to be significantly different (P http://ebcj.mums.ac.ir/article_7654_23f2f52a360efddd9ba2dee7c2ab2dd8.pdfIncentive spirometryRespiratory PatternChronic Obstructive Pulmonary DiseaseResistive Inspiratory Muscle TrainingengMashhad University of Medical SciencesEvidence Based Care2008-24872008-370X2016-10-0163556610.22038/ebcj.2016.76637663مقاله پژوهشی اصیل کمی و کیفیEffect of Lung Manual Hyperinflation (MHI) on Oxygenation of Patients Following Abdominal Surgery and T-Tube SupportJavad Malekzadehmalekzadehj@mums.ac.ir1Mahboube Yazdaniyazdanim1@mums.ac.ir2Alireza Sedaghatsedaghatar@mums.ac.ir3Seyed reza Mazlommazlomr@mums.ac.ir4Evidence Based Care Research Centre, Instructor of Nursing, Instructor of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranMS in Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranAssociate Professor of Anesthesiology and Critical Care, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IranEvidence Based Care Research Centre, Instructor of Nursing, Instructor of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranBackground: Postoperative pulmonary complications (PPC) are of the major reasons for death. Prolonged mechanical ventilation (PMV) and delayed extubation are leading to the incidence of more seriously complications. The effect of hyperinflation has not been investigated in control of these complications in patients who have been weaned from mechanical ventilation and are undergoing T-tube support. Aim: Investigation of MHI effect on oxygenation of patients following abdominal surgery and T-tube support. Method: This clinical trial was performed on 40 patients undergoing abdominal surgery and T-tube support hospitalized in intensive care units of hospitals in Mashhad, Iran, in 2015-2016. The participants were divided randomly into two experimental and control groups. In the experimental group, MHI technique was performed using Mapleson circuit for three twenty-minute periods. The control group received routine hospital care. The two groups were compared for PaO2, PaCO2 and SpO2 before intervention, 5 and 20 minutes after intervention. Data were analyzed using SPSS software. Results: The mean age was 66.7±8.3 and 67.5±9.0 years in experimental and control groups, respectively. In intergroup comparison using independent t-test, the mean PaCO2, PaO2 and SpO2 had no significant differences in the experimental group before the intervention. However, the means SpO2 and PaO2 at 5 and 20 minutes after intervention were significantly higher in the experimental group (phttp://ebcj.mums.ac.ir/article_7663_6b14e5a50c0aef78396c7fbf994dca6e.pdfLung HyperinflationAbdominal SurgeryOxygenationPostoperative Pulmonary ComplicationsengMashhad University of Medical SciencesEvidence Based Care2008-24872008-370X2016-10-0163677610.22038/ebcj.2016.76557655مقاله پژوهشی اصیل کمی و کیفیThe Impact of Smoking Cessation Training-Counseling Programs on Success of Quitting Smoking in Patients with Acute Coronary SyndromeZeinab Kazemzadehkazemzadehz9@mums.ac.ir1Zahra Sadat Manzarimanzariz@mums.ac.ir2Saeed Vagheevaghees@mums.ac.ir3Mahmood Ebrahimiebrahimimh@mums.ac.ir4Sayed Reza Mazlommazlomr@mums.ac.ir5MS nursing student, Medical-Surgical nursing Department, Faculty of Nursing and Midwifery, Mashhad University of Medical sciences, Mashhad, IranAssistant Professor, Evidence Based Care Research Centre, Medical-Surgical nursing Department, School of Nursing and Midwifery, Mashhad University of Medical sciences, Mashhad, IranEducator, Evidence Based Care Research Centre, Psychiatric nursing Department, School of Nursing and Midwifery, Mashhad University of Medical sciences, Mashhad, IranAssociate Professor, Cardiologist, School of Medicine, Mashhad University of Medical sciences, Mashhad, IranEducator, Evidence Based Care Research Centre, Medical-Surgical nursing Department, School of Nursing and Midwifery, Mashhad University of Medical sciences, Mashhad, IranBackground: The smokers who use supportive programs have a greater chance to quit smoking. Smoking cessation recommendation is one of the most important prevention and treatment methods mentioned in care guidelines provided for patients with acute coronary syndrome. Aim: The main objective of this study is to determine the effects of training-counseling programs on smoking cessation in patients with acute coronary syndrome. Method: In this randomized controlled clinical trial, 51 patients with acute coronary syndrome in Ghaem and Imam Reza hospitals in Mashhad, 2015, after filling the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) questionnaire, were categorized into two groups. Intervention group received smoking cessation training-counseling program and control group received some advices/recommendations to quit smoking. After a three-month telephone follow-up, smoking cessation standard questionnaire was filled for all patients. The data were analyzed using SPSS v11.5 and Chi-square test. Results: The age of study participants was 52.6± 7.9 and 56.2±12.3 for intervention and control group, respectively. According to Chi-square test, a significant difference was observed between intervention and control groups in first through fifth stages after the intervention in terms of succeed to quit smoking (phttp://ebcj.mums.ac.ir/article_7655_57d86cdd755617780c90158d5a3f709e.pdfCigarettesmoking cessationTrainingcounseling